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Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review

The detrimental effects of both diabetes mellitus (DM) and hyperglycemia in the perioperative period are well established and have driven extensive efforts to control blood glucose concentration (BGC) in a variety of clinical settings. It is now appreciated that acute BGC spikes, hypoglycemia, and h...

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Autores principales: Canelli, Robert, Louca, Joseph, Hartman, Ciana, Bilotta, Federico
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10294067/
https://www.ncbi.nlm.nih.gov/pubmed/37383597
http://dx.doi.org/10.4239/wjd.v14.i6.783
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author Canelli, Robert
Louca, Joseph
Hartman, Ciana
Bilotta, Federico
author_facet Canelli, Robert
Louca, Joseph
Hartman, Ciana
Bilotta, Federico
author_sort Canelli, Robert
collection PubMed
description The detrimental effects of both diabetes mellitus (DM) and hyperglycemia in the perioperative period are well established and have driven extensive efforts to control blood glucose concentration (BGC) in a variety of clinical settings. It is now appreciated that acute BGC spikes, hypoglycemia, and high glycemic variability (GV) lead to more endothelial dysfunction and oxidative stress than uncomplicated, chronically elevated BGC. In the perioperative setting, fasting is the primary approach to reducing the risk for pulmonary aspiration; however, prolonged fasting drives the body into a catabolic state and therefore may increase GV. Elevated GV in the perioperative period is associated with an increased risk for postoperative complications, including morbidity and mortality. These challenges pose a conundrum for the management of patients typically instructed to fast for at least 8 h before surgery. Preliminary evidence suggests that the administration of an oral preoperative carbohydrate load (PCL) to stimulate endogenous insulin production and reduce GV in the perioperative period may attenuate BGC spikes and ultimately decrease postoperative morbidity, without significantly increasing the risk of pulmonary aspiration. The aim of this scoping review is to summarize the available evidence on the impact of PCL on perioperative GV and surgical outcomes, with an emphasis on evidence pertaining to patients with DM. The clinical relevance of GV will be summarized, the relationship between GV and postoperative course will be explored, and the impact of PCL on GV and surgical outcomes will be presented. A total of 13 articles, presented in three sections, were chosen for inclusion. This scoping review concludes that the benefits of a PCL outweigh the risks in most patients, even in those with well controlled type 2 DM. The administration of a PCL might effectively minimize metabolic derangements such as GV and ultimately result in reduced postoperative morbidity and mortality, but this remains to be proven. Future efforts to standardize the content and timing of a PCL are needed. Ultimately, a rigorous data-driven consensus opinion regarding PCL administration that identifies optimal carbohydrate content, volume, and timing of ingestion should be established.
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spelling pubmed-102940672023-06-28 Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review Canelli, Robert Louca, Joseph Hartman, Ciana Bilotta, Federico World J Diabetes Minireviews The detrimental effects of both diabetes mellitus (DM) and hyperglycemia in the perioperative period are well established and have driven extensive efforts to control blood glucose concentration (BGC) in a variety of clinical settings. It is now appreciated that acute BGC spikes, hypoglycemia, and high glycemic variability (GV) lead to more endothelial dysfunction and oxidative stress than uncomplicated, chronically elevated BGC. In the perioperative setting, fasting is the primary approach to reducing the risk for pulmonary aspiration; however, prolonged fasting drives the body into a catabolic state and therefore may increase GV. Elevated GV in the perioperative period is associated with an increased risk for postoperative complications, including morbidity and mortality. These challenges pose a conundrum for the management of patients typically instructed to fast for at least 8 h before surgery. Preliminary evidence suggests that the administration of an oral preoperative carbohydrate load (PCL) to stimulate endogenous insulin production and reduce GV in the perioperative period may attenuate BGC spikes and ultimately decrease postoperative morbidity, without significantly increasing the risk of pulmonary aspiration. The aim of this scoping review is to summarize the available evidence on the impact of PCL on perioperative GV and surgical outcomes, with an emphasis on evidence pertaining to patients with DM. The clinical relevance of GV will be summarized, the relationship between GV and postoperative course will be explored, and the impact of PCL on GV and surgical outcomes will be presented. A total of 13 articles, presented in three sections, were chosen for inclusion. This scoping review concludes that the benefits of a PCL outweigh the risks in most patients, even in those with well controlled type 2 DM. The administration of a PCL might effectively minimize metabolic derangements such as GV and ultimately result in reduced postoperative morbidity and mortality, but this remains to be proven. Future efforts to standardize the content and timing of a PCL are needed. Ultimately, a rigorous data-driven consensus opinion regarding PCL administration that identifies optimal carbohydrate content, volume, and timing of ingestion should be established. Baishideng Publishing Group Inc 2023-06-15 2023-06-15 /pmc/articles/PMC10294067/ /pubmed/37383597 http://dx.doi.org/10.4239/wjd.v14.i6.783 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Minireviews
Canelli, Robert
Louca, Joseph
Hartman, Ciana
Bilotta, Federico
Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review
title Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review
title_full Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review
title_fullStr Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review
title_full_unstemmed Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review
title_short Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: A scoping review
title_sort preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes: a scoping review
topic Minireviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10294067/
https://www.ncbi.nlm.nih.gov/pubmed/37383597
http://dx.doi.org/10.4239/wjd.v14.i6.783
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AT hartmanciana preoperativecarbohydrateloadtoreduceperioperativeglycemicvariabilityandimprovesurgicaloutcomesascopingreview
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